Maternal mortality: More new moms are dying, but doctors can’t find a single reason why

Danae King More Content Now

Friday

Aug 24, 2018 at 11:07 AMAug 24, 2018 at 11:07 AM

The best day of Antoinette and Haris Pratsinakis’ lives was followed quickly by the worst, when Antoinette had a stroke just four days after delivering their healthy baby girl.That was in 2013. Now, Lucy, the baby, is about to turn 5 and the Pratsinakis’ lives have been forever changed both by Lucy and by Antoinette’s disability, caused by the brain hemorrhage and subsequent stroke.“Time kind of stopped,” Haris said of his wife’s stroke, which left her with a slight vision problem, little use of her left arm and a limp. “Every single day was exhausting. You were just worried, and you’d kind of break down at certain points.”The Pratsinakises aren’t alone. More than 50,000 women and families’ lives are changed each year when the joyful occasion of giving birth turns dangerous, leaving the mother with severe medical problems, a USA Today investigation found.Though many people think giving birth is safer than it’s ever been in this country, the investigation found that the United States is the most-dangerous developed country in which to give birth.“The reasons are complex,” said Dr. Barbara Levy, vice president of health policy at the American College of Obstetricians and Gynecologists, based in Washington, D.C. “One of which is access to health care.”Doctors and health professionals first noticed there was a problem, not only with oft-talked-about infant mortality but also with maternal mortality, about 15 years ago, Levy said.The rates of maternal morbidity began to rise, but medical providers can’t point to any single reason, she said.“Women are older when they’re having babies now, women are far more obese than they were, the cesarean rate has gone up and morbidity is related to multiple c-sections,” Levy said. “But these are associations, not causations.”After realizing the rise in maternal morbidity, several concerned parties came together to consider how to improve the safety with mothers, Levy said. In 2014, Alliance for Innovation on Maternal Health was created and began to send hospitals “bundles,” with instructions and activities for improving care for mothers.For example, a bundle on responding to hemorrhages may advise that a birthing facility or hospital have a hemorrhage cart ready during labor and delivery — but doesn’t say specifically what should be on it. That’s up to each individual facility, Levy said.The bundles already have made a small difference, ACOG statistics show.After implementing bundles on hemorrhage and hypertension, hospitals in four states decreased the average maternal morbidity rate. Before the bundles were implemented, the severe maternal morbidity rate was between 1.9 and 2.1 percent; after, it is between 1.5 and 1.9 percent, according to ACOG.Within the next five years, the program will be implemented in 35 states, but the goal is to get the bundles to care providers in every state, and then in every hospital, Levy said. There are currently nine obstetrician bundles, each covering a maternal health concern or potential cause of complications.Though it’s important for care providers to be prepared for things to go wrong during and after birth, it’s also important that women have better care before they give birth, and long after, Levy said.It’s a systemic problem, not one that can be blamed on any one health provider, Levy said.“It’s states, the government and health policy that have to give women priority,” Levy said. “So many of the deaths and severe problems happen after birth, when women lose Medicaid coverage.”State Sen. Charleta Tavares, D-Columbus, is a member of the Commission on Infant Mortality and has been addressing mothers’ health but not yet maternal morbidity, she said. She hopes to focus more on the issue in the future and thinks raising awareness is important.So do the Pratsinakises,of Hilliard, which is why they told their story.“If we prevent this from happening to another family, it’s worth our time,” said Haris Pratsinakis, 40.Then, he and Antoinette told the story of their baby’s birth on Aug. 19, 2013, and her stroke, on Aug. 24, 2013.“On Monday, she was born, and we went home Wednesday. Everything was fine; we were suffering like all new parents,” Haris said, laughing. Antoinette was beginning to breastfeed the newborn and then Thursday, she had a headache and was feeling tired.They attributed her symptoms to her body recovering from the trauma of birth. Then, they checked her blood pressure with a cuff at home — she’d had high blood pressure during pregnancy, so the couple was used to monitoring it — and it was high. They didn’t know to be alarmed, and a call to the doctor resulted in advice to wait it out.Early Saturday, Antoinette suffered a stroke and major brain hemorrhage on the right side of her brain.She was rushed to the hospital, and a shocked Haris was told there was a 40 to 50 percent chance his 35-year-old wife would die.“I was looking forward to taking care of my healthy child,” Antoinette said. “I never thought ... I thought we were out of the woods already.”For the next 10 weeks, Antoinette would be in the intensive-care unit and an inpatient rehabilitation facility, re-learning how to walk after her left side was affected by the stroke.Lucy helps her stir when it comes to making the girl’s favorite — chocolate chip pancakes — and Haris helps with other daily tasks. The family still hopes her motor skills will improve.Tavares’ strategy has been to get people’s attention by talking about babies’ lives, and then work toward helping making adults healthier.“If the mother’s health is not addressed, it’s more likely ... the infant is going to suffer health issues,” Tavares said. “My hope is that as we look at housing and social determinants of health, that we are looking then at morbidity and mortality of moms as well, and that that’s what we focus on in the next couple years.”

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